Systems thinking in the community: Nothing about us, without us

Gretchen Miller: Hello. This is Prevention Works, the podcast of The Australian Prevention Partnership Centre. I’m Gretchen Miller, and our guest today is Steve Allender, Professor of Public Health and Founding Director of The Global Obesity Centre, or GLOBE, at Deakin University.

And GLOBE is a World Health Organization Collaborating Centre for Obesity Prevention, since 2003. There are so many things we could talk with Steve about today, but we are focusing on what complex systems thinking brings to community-based intervention, or perhaps it should be what community brings to systems thinking? Plus, we’ll consider that elephant in the room climate change and what that brings to bear to systems thinking and obesity and how malnutrition enters the picture.

Steve, let’s start with your abiding interest in the ground level and community engagement. Would you tell us a little bit about your upbringing and how that has influenced your approach through your working life?

Steve Allender: Sure, I was raised in a rural community with a population of about 120 people, and we lived on a farm about 25 kilometres outside of there. It was a pretty self-contained place, and if a problem arose, you typically just got on with it and solved it. And when I think about growing up there, things like building town halls, building gymnasiums for the high school, building sporting centres were basically local people getting together and deciding that this needs to be done, so we will do it. So I guess I saw from a pretty early age how powerful community could be, but also how powerful engaging communities in owning problems for themselves is, in terms of solving problems.

Gretchen Miller: Was there any external support for that community or did the community just get on and self-motivate?

Steve Allender: I think it varied a lot in that varied by scheme. And as we know, sometimes the funding goes in particular directions and sometimes it goes in others. I think probably the key aspect is it was highly adaptable. If the support was there, they would use it to the best of their ability, but quite often the support wasn’t there, this is quite a small rural community, and so they would just have to get on with it, with the resources at hand. And I suppose that’s the other thing that’s led to where we work with communities, working from their point of view, but also working with the resources available. So rather than working together and deciding we need to raise a bunch of money to do something, our starting point is to say, well, what capacity do we have and where’s the best place to apply it?

Gretchen Miller: So, we are talking about community and I guess the question is how we define community, what a community actually is?

Steve Allender: It’s a really interesting question and it’s such a problem because when you say we’re thinking about the community, everybody gets a different picture in their head of what that means and when I think of community, what I’m thinking of is a group of people with a shared interest or a shared problem to solve. So federal cabinet is a particular community with a particular set of problems. COAG is a particular community with a particular set of issues, as is new mums in a small town, as is a local government authority and I think one of the errors we make when we get that mental picture of what community means, is we also then assume that that’s a rigid boundary. But if I think of some of the work we’re doing with Campbelltown, for example, in southwest Sydney, there are multiple communities there defined by faith, defined by their school community, defined by age, defined by the clubs they attend, and when you start thinking of it like that, you lose those boundaries but those points of intersection provide really powerful points for change so the intersection between say a faith community and sporting clubs is probably an incredibly powerful place to support both.

Gretchen Miller: So that’s where I’d like to bring in the idea of systems thinking, which is not a new idea and yet, it’s kind of a buzzword at the moment, but if we look at systems thinking in it’s original and purest intent and what it actually is, maybe we should define that first, and then talk about why systems thinking is such a useful tool when we’re considering the complexities of community.

Steve Allender: I think that the important term there is complexity. So, as you mentioned, there’s actually a really rich tradition in systems thinking and systems thinking really comes from a wide range of disciplines. So, there is a really nice book by Ray Ison that provides a typology of the different disciplines where systems have emerged from the different ways they think about complexity and then the different tools. So we put ourselves in a particular part of the systems landscape, notably system dynamics and adaptive systems and systems complexity but there’s a lot of jargon and there’s a lot of words but what that approach essentially means is we’re pretty interested in understanding the complexity and the relationships of cause and effect around a particular problem as a part of defining a solution to that problem and so, for childhood obesity, for example, in a community we would ask the question, what are the relationships of cause and effect that are leading to this problem? And in each community that will be different, but that didn’t include access to healthy food, but it goes to broader social determinants. So, you will hear often about intergenerational cooking or intergenerational poverty and other sorts of aspects and so what you’re aiming to do is to understand that much broader complexity to then have a shared mental model that allows you to approach solving the problem in a more informed way.

Gretchen Miller: And traditionally when we approach childhood obesity, we just go, okay it’s about BMI, it’s about body mass index?

Steve Allender: Yes, and that’s a really nice point, so we are looking for competitive funding like everybody else from medical research funds and so hard outcome measures like BMI are really important, but actually when we work in communities, we work with them to define the issue they want to approach. So, we measure BMI to see whether weight status has changed, but communities will often focus on mental wellbeing of their kids or improving health literacy or improving access to healthy food. And so obesity is a really important part of the scientific side of what we do – the public facing side of what we do is far more around a positive conception of the health of kids, and more broadly the health of communities.

Gretchen Miller: What might be some of the elements of the system that you have to consider as you look at the surrounding issues?

Steve Allender: So, the way that we approach it is that we identify with the community the key leaders in that community. And we define leaders as people who have authority to improve the environments where kids are either active or make food choices. That’s a really broad conception when you think about it and so we end up with retail leaders, CEOs of councils, but also major business leaders. And to give you one example in Western Victoria, that group of people included key management in the local water company and one of the outcomes was to work to change the taste of water because it was recognised as one of the aspects that lead to poor water consumption. And so, the idea really is to capture the complexity in any given situation with the key leaders who can change that, and so it goes as broad or as narrow as what matters to that group of people.

Gretchen Miller: So, the system includes community leaders, but it also includes the taste of water?

Steve Allender: That’s right.

Gretchen Miller: Quite remarkable, but it also includes more obvious things, perhaps like food availability, various stakeholder groups. Who are the stakeholders? Can you maybe outline just again, the range that we’re talking about here?

Steve Allender: Yes, it’s a huge range. So, you would begin with that typical groups you would start with in terms of capacity building approaches in communities, so that would be the local health services, the local schools, local school kids, local government and that would be a typical sort of starting point and historic.

Historically, one of those agencies would potentially buy a program from somewhere else and run it for a period of time and wonder why it hadn’t worked. We’re starting with that leadership and then asking who else is a part of this system and that spreads to people involved in sporting clubs, faith leaders in the community, but you also have business leaders becoming involved. And so we’ve had interventions across particular towns where the local council has preferenced food providers who only provide a healthy menu and that’s changed the retail landscape in that particular community to drive healthier food. So, it’s as broad and or as narrows as the community wants it to be.

Gretchen Miller: So you’ve been doing this work in some communities for 20 odd years, what kind of shifts in approach and what kind of learnings have you had in doing that work over that period of time?

Steve Allender: It’s a good question and one of the critical aspects to what we’re doing is the intent for capacity building. So, the idea is that if we do this work with the community, there is the ability for that work to continue without us being involved. And one of the things that’s really stood out is how adaptable communities can be when they’re provided with that capacity. So, to give an example, in Western Victoria, we’ve been using systems thinking, particularly group model building to support childhood obesity initiatives across that region, as a result of us building the capacity they are now using those techniques for a whole range of other health issues, notably educational attainment, mental health abuse and more recently as COVID hit, they could immediately pivot to using these techniques to plan their way out of COVID and plan the recovery that they wanted and one of the key aspects of that piece, being able to engage the key community leaders in a shared model of the problem and therefore the solution. It’s been really fascinating to see just how much community can do and there’s a sort of attribution, contribution thing there where we often say, if this works and if this is a success, we won’t be in the photo, it’ll be long after we’re gone that that things are still happening.

Gretchen: So, what you’re building then is a virtuous circle that is possibly more of a spiral, in fact?

Steve Allender: Yes, and one of the aspects of systems science we use it a lot is the idea of feedback loops. So, how do you create a feedback loop that maintains and builds the momentum in a community to improve the health of kids, you know, and that’s a function of interest and desire to do something and awareness of the problem, opportunities and evidence that’s easy to apply, implementing that, learning from that and you know, if that cycle works that then spins off to try something again, and try something again, and try something again.

Gretchen Miller: And that means that it’s quite a flexible approach, isn’t it? So over 20 years, the makeup of a community would change and could change quite dramatically, so you need not to be sort of rusted on in the one approach?

Steve Allender: And that’s where the adaptive side of this comes in. So in a perfect world, what we’re really doing is providing the capacity for a community to understand the complexity of the situation they’re in, engage the evidence about what we know works and implement what’s possible in that community. And if something new came along mid-trial, we would offer it to the community and see whether they wanted to put that in and optimise it based on what they understand about their system. And I think that’s a really critical aspect of this, we’re not, set the design, run it for three years, wonder why it didn’t work, a large part of the science is how do you provide an adaptive process that communities can use in real time?

And to give another example, we have been working across many, many communities and, one of the things we see in every trial is some version of a social or economic shock, and COVID is a really obvious one, but you think within a year we’ve had major bushfires in Gippsland in Victoria and in those communities they are similarly using these techniques to think about how they recover from bushfire, because they can see a way of sharing how they understand the complexity of the problem and see places where they can intervene to make improvements.

Gretchen Miller: So, it becomes quite an organic development of community knowledge and power, I guess. I am interested in as a researcher, quite often funding is limited to a particular time, outcomes need to be expressed in a way that satisfies funding bodies or research bodies. What you’re talking about is something very, very organic. What are some of the challenges as a researcher in selling the potential outcomes, in containing in some way, because I guess if you’ve got a control group and you’ve got a group which is actually experiencing the changes, you know, how is that ethical? You’d have a whole lot of factors pushing and pulling you as a researcher?

Steve Allender: One of the things we’re trying to get to is a generalized systematic process to find the right thing to do at the right time for community. So, we’ve built software that helps them do that and a bunch of other things. So the intervention is an adaptive process, but what we do in intervention design is probably more traditional where we do have an intervention and a comparison group, one of the things you were concerned about was the ethics of providing controls and you’re exactly right. So our previous trials suggested in the first two to three years, you would get a 3–4% reduction in overweight and obesity prevalence, but you also get improvements in mental health, social relationships, and a whole bunch of other things like sleep levels of physical activity. And an argument that a dear friend, Liz Waters used to make is that if you know the thing works you can’t have a control group because it’s unethical. And I think that was a really interesting thought and one of the ways we overcome that is with a design called a step wedge cluster randomized trial, which is a nice term to use to confound your friends and amuse your enemies.

What it means is, let’s say we have 10 communities, those communities each represent a cluster. What we would do is take half of them, randomize half of them into step one, stepped, and the wedges then have these things grow over time, but the first step would be those first five communities get the intervention and the second five communities act as a comparison. And then at the two-year mark, both communities get the intervention. So the design allows those two to be compared against each other, but it also allows you to say to the communities in step two, you won’t miss out on the intervention, but you’ll give us a chance to learn from the first five communities and you’ll get a much better product at that five-year mark. So that’s the way we overcome quite a bit of that ethical concern. The other thing we do a lot, you know, we have really strong relationships with multiple people in those communities and our responsibility is the integrity of that relationship before anything else.

So you asked a question about the time scales and funding and all those sorts of things, one of the major challenges, when your intervention really is to build the capacity of community to use tools to decide what they think is the right thing to do, it’s very hard in a grant application to say the intervention will be giving them a chance to decide for themselves, what grants want to see is the intervention will be it tablet taken at 10am every morning for a week. That’s what the grant wants to see. And then the next line is, and the tablet will weigh 1.2 five milligrams and will be dissolved in one and a half litres of water, that’s what they want to say.

This isn’t that, but the argument we have to make is that we know this is the most powerful way to create a change in free living kids. Our ACE Obesity project showed that it’s the most palatable to government and to the community and to business, and it’s all shown to be effective. So that is a strong argument for, the argument against is the difficulty in defining things, I guess.

Gretchen Miller: How do you maintain stability over much longer-term projects of 20 years?

Steve Allender: These relationships over 20 years have come and grown and shrunk according to funding so that is an element, but part of the reason why we have such a heavy focus on capacity building is because we want to leave a legacy where it’s immune to the fluctuations in fashion and funding for particular health aspects. So, the other thing we’re doing to try and overcome that is our emphasis is on teaching a complex problem-solving approach, which would just so happen to focus on the health of kids in that community. But as I mentioned before, you know, communities we’ve worked in are starting to use these techniques for COVID, for bushfire, for government planning, for water planning and a whole bunch of other different things, which is really gratifying because it shows we have built capacity to use these techniques and they’re clearly at least useful because people are using them but it also means we overcome a little bit that larger grant cycle where we’re doing some work now to try and think about how we would build complex problem solving skills for the kids in those schools so that the next generation of people in those communities is trained in complex problem solving systems thinking.

And we’re also doing that in the university sector where we’re looking to teach whole generations of students, particularly teachers, how they might incorporate systems thinking into the work that they do.

Gretchen Miller: And you’re talking about the Global Obesity Centre when you’re saying we?

Steve Allender: That’s right.

Gretchen Miller: So, I think we’ve kind of covered it, but you referred to this approach as multi-layer and multi-action, have I got that correct?

Steve Allender: Yes, so if we think about the community in Western Victoria, in fact, that involves a representative group at state government level, from education and health, that involves regional level, including health education and the university sector, and at the local level, including all the key community leaders, and those lines of communication allow for the lessons being learned in that community to hit at the state policy level, to hit at the regional coordination level, so that’s one way of looking at it. And then the other way of looking at it is within community we’re also really interested in which of the different layers of community could be affected, so I mentioned before local government, local council shifting their purchasing patterns towards healthy food and that leading to a change in the caterers offerings across that town. That’s one example of that higher level but we would also expect to see changes within the individual classroom. And so, because we’ve taught systems thinking in the schools that had got interested in that we had a situation with before the trial, the nutritionist had real trouble accessing the school because they wanted to go and talk to the kids about apples. After we started the trial, the nutritionists were working with the principals to help map the complexity of the food environment in those schools. And the principals were inviting them to the school to talk to the council and the other teachers about the food environment, because they’d had an opportunity to co-create and share the development of the understanding it led to a much more engaged relationship and so the nutritionists were then able to work with the kids on how the local system affected their food choices, whereas before they couldn’t gain access.

Gretchen Miller: And co-create is the key word there. I also wonder if it’s not becoming a bit of a buzz word? How do we make sure that words like co-create maintain their meaning?

Steve Allender: That’s a great question and I’ve got two PhD students working directly on this one specifically around what is co-design, cocreation, coproduction as it applies to food retail outlets, if we were to co-produce new food, retail outlets with retailers and food suppliers, what would that look like? What would co-creation look like? And there’s some real wobble in the language between those different terms. And what we’re thinking about is nothing about us, without us. And what we’re thinking is those communities are involved in setting the direction, setting the tone, setting the level of action that’s done. So, that’s how we think about co-creation. But again, that’s difficult in the funding system where you have to write a very detailed application. But as an example of that, we would go to the community and say, well before we got funded, we were working together on this and we agreed to partner on this. How do you want this to look to your community? And one community will talk about child health and the next will talk about intergenerational relationships and health because they’re the relevant things that they want to point their systems thinking towards.

Gretchen Miller: So, nothing about us, without us, and that’s not about consultation that is about genuine back and forth, which can be quite hard work let’s face it sometimes when you feel like you know the answer?

Steve Allender: That’s the point. We don’t know the answer. You know, we have an evidence base that says in an RCT that was heavily controlled it looks like calorie restriction might have some mild impact that rebounds on childhood obesity, that’s what we know. The other thing we know is that if we’re going to get genuine change and we don’t engage the people that are going to make the change, it won’t happen. So our focus is on giving the science of the process to get the best understanding of complexity, the science of how you integrate the evidence we know into that response and the science of working out, whether doing that is better than doing nothing or better than doing what we traditionally do.

Gretchen Miller: So that’s a real challenge for researchers who might, and perhaps justly so, because they’ve spent 5, 10, 20 years becoming experts, see themselves as experts in a particular field. How do you change that thinking amongst your colleagues?

Steve Allender: Yeah, I think it helps that my PhD is in discourse analysis. So, there’s a lot of work in there around the power of language and reproduction of held positions and so on. If your framing is that language is important, and that expert positioning is something most people use language to do without even thinking about it. And on the other hand of the coin, we know we need the leaders to engage and own the response. It changes who you are completely in that relationship, I’m a servant to the community, they’re not doing me a favour (well they are doing me a favour) by participating in the study – we’re together creating a response that makes sense to a problem that’s important to them.

I wandered off topic a bit there … you’re asking about how we shift the way that, other actors see it. I think there’s value in all of those perspectives. So, we would use an evidence base that had shown the impact of changing food choices. For example, if it was from a controlled study, but we’d say this is a controlled study. So if it’s going to work here, it has to work because you want it and because you can fit it into the local system, and then I think about getting our work published. So we published one of the first causal loop diagrams, which is a systems map version of it about five years ago in PLOS One and getting that published was nearly impossible because it hadn’t really been done before at all and now I see the similar sort of thing being published, you know, fairly regularly from us and from other groups. And the way I think of research is if we know how to do it, it’s not research, right. The problems we should be working with in our research are things we can’t solve. So, I expect it to be hard and I expect that there’ll be a lag time between us doing the work and people catching up and saying that that’s actually a valuable way to do it.

Gretchen Miller: Sure, now tell me about STICKE, Systems Thinking In Community Knowledge Exchange, what is it?

Steve Allender: STICKE is a piece of software, web-based software, and basically what it does is allow anybody to learn in a relatively short period of time, how they can build a causal loop diagram, what some people call a systems map, using techniques that come from the science so that they are informed by the science, but don’t require a really expensive piece of software or a PhD in modelling to use.

So the idea for STICKE came when I was really frustrated that to get somebody to do systems work in a community, it would be a consultant they’d charge $50 to $60,000 that’d be a glossy brochure at the end of it. And the community would look around and go, what was that all about? What we needed to do was to give the communities a tool where they could share how they saw the problem in a way that was informed by the systems science. So, what STICKE does is allow somebody in that community who’s been trained to facilitate a session with their working group or the broader community to develop a shared understanding of the system. And then STICKE allows them to identify where actions might be, identify the key actors, and then track how those things are changing over time, how the system is changing, how the actions are changing and how the interaction of stakeholders is changing over time. And the software itself has developed over time because we work with the community, Western Victoria, Campbelltown, some of our partners in Europe and we’ll say, okay, what else do you need this to do to be useful? And so that’s how it evolves to be what it is today.

Gretchen Miller: Fantastic, thank you. So you’ve done a lot of work in a lot of different communities, not just the Australian scenario. How do you have to adapt your thinking when you’re working in a place which is quite different?

Steve Allender: Yeah, it’s interesting because we’ve used this approach in the South Pacific and Fiji, and planning too in Samoa, and we’ve also worked in multiple countries across Europe, including the UK, Poland, South Africa, and a whole range of different places, and the other kind of cool thing is STICKE now speaks I think about seven languages and, including Russian, which is kind of hilarious. I might turn that around the other way think about it this way –I don’t think you could talk to any community leader and ask them whether they want to improve the health of the community – nobody says no. So, the starting point is really a shared understanding that there’s something we could improve and then our offer to that community is to say, well, we’ve developed a way that might be helpful, do you want to give it a try? And so we really heavily de-risk the loss of social capital by a leader in a community saying there’s this fabulous thing we bought it for 50 grand or whatever they pay a consultant and now we’re going to do it this way and that immediately will turn half the room off. And whichever agency has got that single pot of funding is then, you know, different or the others. We go in and say, we’d like to work with you, can you bring the leaders together? Let’s try for two-hour session and we work with STICKE with them and they map the first version of how they see a problem and at the end of that session, we’re then able to say, well, if you don’t like that very much, that was just the Deakin thing that worry about it, or if you found that useful, we’d be happy to help you learn how to do the next steps and give you the tools to do it. And so far we’ve probably worked in 500 or 600 separate communities we have yet to have the response of, we don’t get it and we don’t like it well, and that’s a very top of head guess, but, but lots of different places all around the world.

And I think the key reason why we get that is several. We deliberately use techniques from group model building, which are participatory and increasing engagement. We deliberately ask what the problem looks like from those people’s point of view. And after that, they’re fully engaged because, you know, they’re used to someone coming in and saying, well, you’ve got higher blood pressure than the next neighbourhood so this is what we are going to do, it’s unusual for someone to come and say, we’ve got some ways that might helpful, we’d like to see whether they’re useful and learn from you how we can make it better. It’s just a different relationship on the way in – so how that differs community to community, what it means is we are adaptive to what that community needs. So, when we worked in Fiji and in the first couple of years of this century, you know, that would involve being part of key meetings across the village. It means the principle networks are key but because we engage but because we engage with that local leader, they tell us the right ways to work with that community. I am just trying to think of some other examples. So the faith communities are really big in South Pacific and Fiji, for example, and similarly, some of the work we’re doing in Poland, the group there have identified a very different group of stakeholders than you might see in the UK or in the study in Portugal.

Gretchen Miller: So I’d like to change direction now and we’ve got a couple of big elephants in our global room, one of which is climate change, one of which is malnutrition, you call a syndemic, multiple epidemics in one, a number of wicked problems coming together?

Steve Allender: Yes, this was part of a Lancet Commission on obesity and the Lancet Commission brings together in that case 40 leaders from around the world in a particular topic area to set the sort of direction for the next 20 to 50 years saying this is where we think we need to go, if we’re going to do something about this problem. It started off as a Lancet Commission on obesity, led by Boyd Swinburn and Bill Dietz, and they recruited a group of people from around the world and we had been using this idea of systems thinking at the time so in the transition into their thinking on that, and one of the key things is to try and understand the whole picture and the interdependencies rather than ignore them. So in a randomized control trial, you’re trying to randomize outcome context, all you’re trying to do is see the effect of the tablet versus not having the tablet and randomizing takes out all the issues around, age or ethnicity and those sorts of things.

And the shift of systems thinking says, actually that context is really important, we need to understand how things are interdependent, how that’s different in a specific context, because they are the things that will determine whether what we do is successful or not, and should determine what we do in the first place. When you apply that lens to thinking about obesity and thinking about the drivers of obesity, particularly being overconsumption of energy, dense food, and also reducing levels of activity, they’re really analogous or aligned, completely related to, malnutrition in all its forms, so obesity being one of those, but also climate change because at the root of each of those problems.

If you take a global view, is overconsumption and that includes overconsumption of energy dense foods, but the way they’re produced, the way they’re transported and so on and so on. So if the question is what is the next 50 years look like and what’s an ambitious target then an ambitious target is to deal with this syndemic by approaching climate change and malnutrition and all its forms as the key targets for change.

Gretchen Miller: And I mentioned wicked problems before, wicked problems by definition, well, what are they?

Steve Allender: I use the idea of a tangle devolving beastie, but they’re problems that have multiple interdependencies and don’t necessarily respond the way you think they do when you intervene.

Gretchen Miller: So where does this lead you to when you’ve got so many enormous factors, and so many variants in the local expression of them, where does that research then take you?

Steve Allender: Yeah, it’s a really good question and I mean it’s our research agenda for the next little while but from our point of view we work at everything from global policy through to an individual classroom, and everywhere in between, so we have a lot of work. Gary Sacks’ work for example, around international policy levers, all the way through to individual community level interventions.

One of the things to consider as this idea of double and triple-duty actions. So double and triple-duty actions are interventions changes, policy levers, policy changes that act on more than one of those three things, malnutrition in all its forms, plus obesity and climate change and so that involves the way we prepare and ship our food and so on and so on. So, when we think about where it leads you, we do have some ideas about what those policy options mean but there’s a lot of open questions about how do we start impacting on those multiple dimensions of over-consumption that lead to obesity, malnutrition, and climate change?

Gretchen Miller: When we chatted the other day, you made a really interesting point about the notion of expertise and having started our conversation with the incredibly local, regarding communities, I would like to finish it with a consideration of what expertise is and what it isn’t and how questioning that definition can actually really make a difference to community work?

Steven Allender: That’s interesting because it brings to mind the conversation we had about Foucalt and the use of language to establish positions of power and positions of difference. Some communities value being able to present an expert to support getting the work done. So, there are phases where having the professor present the work helps, it’s more often that positioning yourself as expert is detrimental.

I mean it when I say the interventions and the way they’re designed in communities rely really heavily on how those people understand their community, which is something we will never be able to do from a distance. So to try to position ourselves as experts on what any particular community, (a) needs and (b) what approach to that is going to be most effective, is pretty naive. And the legitimate need for policy change to improve health is right because it’s a blanket approach, but it has differential effects room by room, community by community. And so I think a blend of both is essential, but generally speaking I think expert positioning of an external party is counterproductive.

So, we would spend a lot of time demonstrating how that expertise was shifting to within a community and that we weren’t needed anymore. And we point that at obesity at the moment, but we also use these techniques for intimate partner violence and housing affordability, and a whole bunch of other things, so our job is to put the right tools, in the right hands, at the right time, to get the best possible impact on health.

Gretchen Miller: Steve, thank you so much for your time. Steve Allender is Professor of Public Health and Founding Director, The Global Obesity Centre, or GLOBE, at Deakin University in Victoria. There’s more information on the website of The Australian Prevention Partnership Centre, just look for Prevention Works. Steve has a great explainer video here about his work in Western Sydney and Victoria interventions in obesity.

I’m Gretchen Miller. This is Prevention Works. Share us, like us, leave us a review. We love to hear from you. See you next time.